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Biomedical subjects

H Jørgensen

Publications and source records attributed to H Jørgensen.

At least 19 recordsLinked to original sources
PubMed2006

BCR-ABL activity and its response to drugs can be determined in CD34+ CML stem cells by CrkL phosphorylation status using flow cytometry.

In chronic myeloid leukaemia, CD34(+) stem/progenitor cells appear resistant to imatinib mesylate (IM) in vitro and in vivo. To investigate the underlying mechanism(s) of IM resistance, it is essential to quantify Bcr-Abl kinase status at the stem cell level. We developed a flow cytometry method to measure CrkL phosphorylation (P-CrkL) in samples with <10(4) cells. The method was first validated in wild-type (K562) and mutant (BAF3) BCR-ABL(+) as well as BCR-ABL(-) (HL60) cell lines. In response to increasing IM concentration, there was a linear reduction in P-CrkL, which was Bcr-Abl specific and correlated with known resistance. The results were comparable to those from Western blotting. The method also proved to be reproducible with small samples of normal and Ph(+) CD34(+) cells and was able to discriminate between Ph(-), sensitive and resistant Ph(+) cells. This assay should now enable investigators to unravel the mechanism(s) of IM resistance in stem cells.

Adaptor Proteins, Signal Transducing↗
PubMed2006

Effects of increasing dietary concentrations of specific structured triacylglycerides on performance and nitrogen and energy metabolism in broiler chickens.

Specific structured triacylglycerides (STG) containing medium chain fatty acids in sn-1,3 positions and a long chain fatty acid in sn-2 position were prepared from rapeseed oil and capric acid (C10:0). A total of 80 female broiler chickens (Ross 208) were randomly allocated into five dietary treatments as two series of 40 chicks: a basal diet with graded levels of STG of 0, 20, 40, 60 and 80 g/kg diet at the expense of rapeseed oil were fed to the chickens in groups of four. At 12 d of age the chickens were placed pair-wise in metabolism cages. The grower period (d 13-36) was divided into four consecutive balance periods each of 6 d. Two 24 h measurements of gas exchange in two open-air circuit respiration chambers were performed during the second and third day of each balance period. During the whole experiment there was a negative effect of the inclusion of STG on average feed intake. However, this only slightly affected average daily weight gain. Feed conversion efficiency improved linearly with the inclusion level of STG. Daily gain adjusted to mean daily feed intake increased linearly with inclusion rate of STG, indicating that the weight gain was affected by both feed intake and the enhancing effect on digestibility of STG. Weight of small intestine and colon decreased with increasing inclusion of STG. Utilisation of dietary protein relative to intake increased while that of retained fat tended to decrease resulting in a decreased utilisation of metabolisable energy (RE/ME) in birds receiving STG. Heat production (HE) was slightly lower in the STG groups. More of the dietary fat was oxidised when more STG was added, although the total amount of fat in the diets was kept constant.

Animals↗
PubMed2004

Effects of short-chain fatty acids and lactic acids on survival of Oesophagostomum dentatum in pigs.

The direct influence of intracaecal infusion of short-chain fatty acids (SCFA) and lactic acids (LA) on already established Oesophagostomum dentatum infection in cannulated pigs was investigated. We tested the hypothesis that the previously discovered anti-parasitic effect of inulin is mediated through its metabolic products SCFA and LA by infusing into cannulated pigs these compounds in amounts approximating to those produced in the pigs large intestine and caecum during the metabolism of inulin. The experiment comprised of 18 pigs--2 groups of 9 pigs in each. The normal diet used in the experiment was based on barley flour with insoluble fibre from oat husk with added soybean meal, vitamins and minerals. After 2 weeks of adaptation to the diet all the pigs were inoculated with 6,000 infective larvae of O. dentatum. Six weeks later, surgery on all pigs was performed to install cannulas into caeci. At 7 weeks post-infection (p.i.) the SCFA and LA infusion was initiated in Group 1 (experimental) pigs; at the same time pigs in Group 2 (controls) were infused with saline. At week 10 p.i., all pigs were killed and their worm burdens determined. SCFA and LA infused pigs exhibited markedly reduced fecal egg counts and worm recoveries (98 and 92% reduction, respectively, compared to saline controls). The results from this study demonstrate that SCFA and LA have a significant negative influence on established O. dentatum infection in growing pigs. The results also show that the type of dietary carbohydrates fed and its intestinal degradation can yield metabolic by products that profoundly influence helminth survival.

Animals↗
PubMed2003

Serotonin receptors involved in vasopressin and oxytocin secretion.

Serotonin (5-HT), 5-HT agonists, the 5-HT precursor 5-hydroxytryptophan, 5-HT-releasers and -reuptake inhibitors stimulate the release of vasopressin and oxytocin. We investigated the involvement of 5-HT receptors in the serotonergic regulation of vasopressin and oxytocin secretion. Vasopressin and oxytocin secretion was stimulated by 5-HT, the 5-HT(1A+1B+5A+7) agonist 5-carboxamidotryptamine (5-CT), the 5-HT(2A+2C) agonist DOI, the 5-HT(2C+2A) agonist mCPP, the 5-HT(2C) agonist MK-212, the 5-HT(3) agonist SR 57277 and the 5-HT(4) agonist RS 67506. The 5-HT(1A) agonist 8-OH-DPAT, which had no effect on vasopressin secretion, stimulated oxytocin secretion. The 5-HT-induced release of vasopressin and oxytocin was inhibited by central infusion of the 5-HT antagonists WAY 100635 (5-HT(1A)), LY 53857 (5-HT(2A+2C)), ICS 205-930 (5-HT(3+4)) and RS 23597 (5-HT(4)). The 5-HT2+6+7 antagonist metergoline in combination with the 5-HT1A+2+7 antagonist methysergide inhibited the stimulatory effect of 5-CT on both hormones, whereas the 5-HT1A+1B antagonist cyanopindolol only inhibited the oxytocin response. The 5-HT(2A) antagonist 4-(4-flourobenzoyl)-1-(4-phenylbutyl)-piperidine oxalate had no effect on DOI-induced hormone response. The 5-HT(2C) antagonist Y 25130 partly inhibited the stimulating effect of MK-212. ICS 205-930 and RS 23597 inhibited vasopressin and oxytocin secretion induced by RS 67506. WAY 100635 inhibited 8-OH-DPAT-induced oxytocin secretion. We conclude that 5-HT-induced vasopressin secretion primarily is mediated via 5-HT(2C), 5-HT(4) and 5-HT(7) receptors, whereas 5-HT(2A), 5-HT(3) and 5-HT(5A) receptors seem to be of minor importance. 5-HT-induced oxytocin secretion involves 5-HT(1A), 5-HT(2C) and 5-HT(4) receptors; in addition an involvement of 5-HT(1B), 5-HT(5A) and 5-HT(7) receptors seems likely, whereas 5-HT(2A) and 5-HT(3) receptors seem to be less important.

8-Hydroxy-2-(di-n-propylamino)tetralin↗
PubMed2003

Serotonin stimulates hypothalamic mRNA expression and local release of neurohypophysial peptides.

The neurotransmitter serotonin (5-HT) stimulates the secretion of vasopressin and oxytocin, and 5-HT is involved in the mediation of the vasopressin and oxytocin response to stress. In male Wistar rats, we investigated the 5-HT receptors involved in the 5-HT-induced increase of mRNA expression of vasopressin and oxytocin in the hypothalamic paraventricular nucleus (PVN) and supraoptic nucleus (SON). The 5-HT precursor, 5-hydroxytryptophan, injected in combination with the 5-HT reuptake inhibitor, fluoxetine, increased oxytocin mRNA expression in the PVN, and the concentration of vasopressin and oxytocin in plasma, whereas mRNA in the SON was not affected. Intracerebroventricular infusion of 5-HT agonists selective for the 5-HT1A, 5-HT1B, 5-HT2A and 5-HT2C receptor increased oxytocin mRNA in the SON and PVN. Infusion of agonists selective for the 5-HT2A + 2C receptor increased vasopressin mRNA in the PVN, whereas none of the 5-HT agonists affected vasopressin mRNA in the SON. All the 5-HT agonists infused increased peripheral oxytocin concentration and vasopressin was increased by stimulation of the 5-HT2A, 5-HT2C and 5-HT3 receptor. Intracerebroventricular infusion of 100 nmol 5-HT increased the extracellular hypothalamic concentration of vasopressin as measured by microdialysis in the PVN. To evaluate the involvement of hypothalamic-pituitary system in the 5-hydroxytryptophan and fluoxetine-induced vasopressin secretion, rats were immunoneutralized with a specific anti-corticotropin-releasing hormone antiserum. This treatment reduced plasma vasopressin and oxytocin responses. We conclude that stimulation with 5-hydroxytryptophan or 5-HT agonists increases mRNA expression of oxytocin in the PVN and the SON via stimulation of at least 5-HT1A, 5-HT1B, 5-HT2A and 5-HT2C receptors. Vasopressin mRNA in the PVN was increased only via the 5-HT2 receptor, whereas vasopressin mRNA in the SON does not seem to be affected by 5-HT stimulation. Corticotropin-releasing hormone appears to be partly involved in the mediation of 5-HT induced vasopressin and oxytocin secretion.

Animals↗
PubMed2003

Histamine and prostaglandin interaction in regulation of oxytocin and vasopressin secretion.

Prostaglandins and histamine in the hypothalamus are involved in the regulation of oxytocin and vasopressin secretion, and appear to be involved in the mediation of pituitary hormone responses to immunochallenges. Therefore, we investigated in conscious male rats: (i) whether blockade of H1 or H2 receptors affected the oxytocin and vasopressin responses to prostaglandins and (ii) whether blockade of prostaglandin synthesis affected the oxytocin and vasopressin responses to histamine or to Escherichia coli lipopolysaccharide (LPS), in order to determine any interaction between prostaglandins and histamine in the hypothalamus. Oxytocin secretion was dose-dependently stimulated by intracerebroventricular infusion of 1 or 5 microg of PGE1, PGE2 or PGF2alpha, with PGE2 being the most potent of the compounds used. Prior central infusion of the H1 receptor antagonist mepyramine or the H2 receptor antagonist cimetidine significantly inhibited the oxytocin response to all three prostaglandins by approximately 50%. Vasopressin secretion was increased by PGE1 but not by PGE2 or PGF2alpha. The stimulatory effect of PGE1 was almost annihilated by prior administration of mepyramine or cimetidine. Central infusion of histamine or immunochallenge with LPS administered intraperitoneally increased oxytocin and vasopressin secretion four- and two-fold, respectively. Pretreatment with systemic injection of the prostaglandin synthesis inhibitor indomethacin dose-dependently reduced the oxytocin response and prevented the vasopressin response to histamine or LPS. We conclude that histamine and PGE1, PGE2 or PGF2alpha interact in the regulation of oxytocin secretion, whereas histamine and only PGE1 interact in the regulation of vasopressin secretion. Furthermore, histamine as well as LPS may affect oxytocin and vasopressin neurones via activation of prostaglandins, probably in the hypothalamic supraoptic nucleus.

Animals↗
PubMed2003

Energy metabolism and protein balance in growing rats fed different levels of dietary fibre and protein.

A study was performed to investigate the effect of different levels of dietary fibre (DF) and dietary protein on visceral organ size, digestibility, nitrogen balance and energy metabolism in rats. Thirty-six male Wistar rats, initial body weight about 76 g were used in a factorial design consisting of three levels of DF (low, 100 g/kg DM: medium, 250 g/kg DM and high, 290 g/kg DM) and two levels of dietary protein (low, 120 g/kg DM and high, 223 g/kg DM). The added fibre source was soybean hulls and Danish fish meal was used as sole source of dietary protein. Measurements of gas-exchange were done on six rats (one group) while urine and faeces were collected individually. The ratio of food/empty body gain increased (P<0.05) with increasing DF and decreasing levels of dietary protein. The weight of the digestive tract was larger (P<0.05) in rats fed the high fibre diet than in those fed the low fibre diet. The digestibility of nutrients and energy decreased linearly with increasing level of soybean fibre (P<0.05). An increased intake of DF was associated with a concomitant loss of protein and energy to faeces. The microbial degradation of NSP and other unabsorbed carbohydrates caused considerably changes in N metabolism of the colon. In rats fed the low protein diets increased levels of DF decreased N excretion in urine and increased N excretion in faeces, while the ratio of retained/digested protein remained constant. When rats were fed the high protein diet protein retention dropped in response to DF both absolute and relative to digested amount, indicating that energy intake could be a limiting factor. Heat production as a percentage of metabolizable energy (HP/ME) was higher (P<0.05) in rats fed the low protein diet than in rats fed the high protein diet, but no significant difference was found among DF levels.

Animals↗
PubMed2002

Fed-batch cultivation of baker's yeast followed by nitrogen or carbon starvation: effects on fermentative capacity and content of trehalose and glycogen.

An industrial strain of Saccharomyces cerevisiae (DGI 342) was cultivated in fed-batch cultivations at a specific growth rate of 0.2 h(-1). The yeast was then exposed to carbon or nitrogen starvation for up to 8 h, to study the effect of starvation on fermentative capacity and content of protein, trehalose and glycogen. Nitrogen starvation triggered the accumulation of trehalose and glycogen. After 8 h of starvation, the content of trehalose and glycogen was increased 4-fold and 2-fold, respectively. Carbon starvation resulted in a partial conversion of glycogen into trehalose. The trehalose content increased from 45 to 64 mg (g dry-weight)(-1), whereas the glycogen content in the same period was reduced from 55 to 5 mg (g dry-weight)(-1). Glycogen was consumed faster than trehalose during storage of the starved yeast for 1 month. Nitrogen starvation resulted in a decrease in the protein content of the yeast cells, and the fermentative capacity per gram dry-weight decreased by 40%. The protein content in the carbon-starved yeast increased as a result of starvation due to the fact that the content of glycogen was reduced. The fermentative capacity per gram dry-weight was, however, unaltered.

Biomass↗
PubMed2002

Serotonergic stimulation of corticotropin-releasing hormone and pro-opiomelanocortin gene expression.

The neurotransmitter serotonin (5-HT) stimulates adrenocorticotropic hormone (ACTH) secretion from the anterior pituitary gland via activation of central 5-HT1 and 5-HT2 receptors. The effect of 5-HT is predominantly indirect and may be mediated via release of hypothalamic corticotropin-releasing hormone (CRH). We therefore investigated the possible involvement of CRH in the serotonergic stimulation of ACTH secretion in male rats. Increased neuronal 5-HT content induced by systemic administration of the precursor 5-hydroxytryptophan (5-HTP) in combination with the 5-HT reuptake inhibitor fluoxetine raised CRH mRNA expression in the paraventricular nucleus (PVN) by 64%, increased pro-opiomelanocortin (POMC) mRNA in the anterior pituitary lobe by 17% and stimulated ACTH secretion five-fold. Central administration of 5-HT agonists specific to 5-HT1A, 5-HT1B, 5-HT2A or 5-HT2C receptors increased CRH mRNA in the PVN by 15-50%, POMC mRNA in the anterior pituitary by 15-27% and ACTH secretion three- to five-fold, whereas a specific 5-HT3 agonist had no effect. Systemic administration of a specific anti-CRH antiserum inhibited the ACTH response to 5-HTP and fluoxetine and prevented the 5-HTP and fluoxetine-induced POMC mRNA response in the anterior pituitary lobe. Central or systemic infusion of 5-HT increased ACTH secretion seven- and eight-fold, respectively. Systemic pretreatment with the anti-CRH antiserum reduced the ACTH responses to 5-HT by 80% and 64%, respectively. It is concluded that 5-HT via activation of 5-HT1A, 5-HT2A, 5-HT2C and possibly also 5-HT1B receptors increases the synthesis of CRH in the PVN and POMC in the anterior pituitary lobe, which results in increased ACTH secretion. Furthermore, the results indicate that CRH is an important mediator of the ACTH response to 5-HT.

Adrenocorticotropic Hormone↗
PubMed2002

Energy and protein metabolism in pregnant sows fed two levels of dietary protein.

The present study was performed to quantify the energy and nutrient metabolism of pregnant sows fed high (HP) or low (LP) dietary protein [18.3 vs. 13.5% of dry matter (DM)]. A total of nine sows (four on HP and five on LP diet) were subjected to balance and respiration trials four times during their second pregnancy (approximately on days 30, 61, 80 and 104 of gestation). The digestibility of protein (83.0 vs. 79.9) (p < 0.01) and energy (84.9 vs. 83.7%) (p < 0.05) was higher for the HP diet. Daily intake of metabolizable energy (ME) and retained energy (RE) were similar for the two groups, with an average of 28.37 MJ ME and 3.94 MJ RE, respectively. Heat production (HE) measured according to the respiratory quotient (RQ) and carbon-nitrogen (CN) method was similar (464 vs. 454 kJ/kg 0.75/day, respectively). Sows fed HP retained more energy in protein (3.33 vs. 2.00 MJ/day) (p < 0.001) and tended to retain less energy in fat (1.59 vs. 2.50 MJ/day) than LP sows. Retained nitrogen (N) (22.3 vs. 13.4 g/day) (p < 0.001) and utilization of N (retained/digested) (45.2 vs. 38.1%) was higher for HP sows compared with LP sows. In late pregnancy, retained N, retained fat, HE and oxidation of carbohydrates increased, while oxidation of fat was reduced to zero. In conclusion, both diets provided adequate N for retention in maternal tissue and conception products. In spite of the lower utilization of N in LP sows, the N excretion was depressed by 5.6 g/day compared with HP sows, because of the lower N intake.

Animals↗
PubMed2001

The p120 catenin partner Kaiso is a DNA methylation-dependent transcriptional repressor.

We describe a novel mammalian DNA binding activity that requires at least two symmetrically methylated CpG dinucleotides in its recognition sequence, preferably within the sequence 5'CGCG. A key component of the activity is Kaiso, a protein with POZ and zinc-finger domains that is known to associate with p120 catenin. We find that Kaiso behaves as a methylation-dependent transcriptional repressor in transient transfection assays. Kaiso is a constituent of one of two methyl-CpG binding complexes originally designated as MeCP1. The data suggest that zinc-finger motifs are responsible for DNA binding, and may therefore target repression to specific methylated regions of the genome. As Kaiso associates with p120 catenin, Kaiso may link events at the cell surface with DNA methylation-dependent gene silencing.

Animals↗
PubMed2001

[Late, life-threatening bleeding after hemorrhoidectomy].

Two patients with severe late rectal bleeding after haemorrhoidectomy are described. Both were suffering from alcohol-induced cirrhosis. The first patient died, because of a late diagnosis and treatment in combination with coagulation disturbances. We call attention to the difference between haemorrhoids and anorectal varices and also to the importance of keeping in mind the possibility of massive bleeding several days after haemorrhoidectomy.

Diagnosis, Differential↗
PubMed2001

Impact of diets varying in dietary fibre characteristics on gastric emptying in pregnant sows.

The effects of feeding two fibre-rich diets with contrasting solubility and a concentrated low dietary fibre on the rate of gastric emptying were examined in six gastric cannulated pregnant sows. Additionally, it was examined whether any effect could be related to the physico-chemical properties of digesta, i.e. viscosity and/or water binding capacity. The sows were fed each diet for one week in a 3 x 3 Latin Square design and the samples were taken in a randomised order 0.5, 1, 2, 3, 5 and 15.5 h after the morning meal. The stomach contents were evacuated through the gastric cannula once daily. The evacuated gastric digesta was quantified and a representative sample was taken to determine its viscosity, water binding capacity and its content of dry matter, dietary components and solid (Cr2O3) and liquid (polyethylene glycol) phase markers. The flow of liquid digesta was calculated as the difference between digesta and dry matter. Increasing the content of dietary fibre in the diet led to higher recovery of liquid digesta but did not have any significant effect on the gastric emptying of dry matter and dietary components. The effect of dietary fibre could not be attributed to the viscosity of the liquid phase of digesta but might be related to the ability of the increased gastric dietary fibre content to hold water. The stomach selectively retained the insoluble dietary fibre components most noticeably seen with the bran-supplemented diet where the concentration of insoluble NSP in digesta increased significantly from 2 hours and onward.

Animals↗
PubMed2001

Effect of peri- and postoperative epidural anaesthesia on pain and gastrointestinal function after abdominal hysterectomy.

In a double blind study we have investigated the effects of epidural local anaesthesia (LA), when added to general anaesthesia (GA) and postoperative paracetamol and NSAID, on postoperative pain and gastrointestinal function in patients undergoing open hysterectomy. Sixty patients were randomized into three study groups: GA, and postoperative paracetamol and NSAID (GA, n=20); GA, paracetamol, NSAID, intraoperative epidural lidocaine and 24-h postoperative epidural saline (Saline, n=20); or GA, paracetamol, NSAID, intraoperative epidural lidocaine and 24-h postoperative epidural bupivacaine (Bupi, n=20). Patients were observed for 72 h postoperatively. Pain at rest, during cough, and mobilization, request for supplementary morphine, and time to first postoperative flatus, was reduced in patients receiving 24-h postoperative epidural anaesthesia, compared with the two other groups. However, these effects of epidural LA, were not sustained beyond the period of infusion, and no differences in PONV, time to first postoperative defecation, mobilization or time to discharge from hospital were observed between groups. A 24 h postoperative epidural infusion with bupivacaine, when added to postoperative paracetamol and NSAID, reduces pain and opioid requirements, but has only limited effects on gastrointestinal function and patient recovery.

Acetaminophen↗
PubMed2001

Effect of epidural bupivacaine vs combined epidural bupivacaine and morphine on gastrointestinal function and pain after major gynaecological surgery.

In a double-blind study, we investigated the effects of postoperative epidural local anaesthetic, with or without addition of epidural morphine, on postoperative pain and gastrointestinal function in patients scheduled for radical hysterectomy and pelvic lymphadenectomy. Forty patients were randomized into two study groups: 48-h postoperative epidural 0.2% bupivacaine 8 ml h(-1) (bupi group) or 48-h postoperative epidural 0.2% bupivacaine/morphine 50 microg at 4 ml h(-1) (bupi/morph group). Patients were observed for at least 96 h after surgery. No differences in pain at rest, during cough or mobilization were observed. Patients in the bupi group requested a significant greater amount of supplementary analgesics, but times to first flatus and defaecation were reduced compared with patients in the bupi/morph group. Itching was a significant problem in patients in the bupi/morph group. No differences in postoperative nausea and vomiting, mobilization or time to discharge from hospital were observed between groups. The addition of morphine to postoperative epidural bupivacaine has only limited effect on pain relief and increases time to normalization of gastrointestinal function.

Adult↗
PubMed2001

Differential effect of serotonin 5-HT(1A) receptor antagonists on the secretion of corticotropin and prolactin.

Serotonin (5-HT) participates in the neuroendocrine regulation of corticotropin (ACTH) and prolactin (PRL) secretion. We investigated the involvement of the 5-HT(1A) receptor in the mediation of ACTH and PRL response to the 5-HT(1A) receptor agonists 8-OH-DPAT and 5-HT, the 5-HT precursor 5-hydroxytryptophan (5-HTP) and restraint stress in male rats. Prior intracerebroventricular (i.c.v.) infusion of the 5-HT(1A) antagonists WAY-100635 and LY-206130 inhibited PRL and ACTH responses to i.c.v. infusion of 8-OH-DPAT, 5-HT as well as to 5-HTP administered systemically in combination with the 5-HT reuptake inhibitor fluoxetine (Flx). Infused i.c.v. NAN-190 inhibited the ACTH response to 8-OH-DPAT i.c.v. Intraperitoneal (i.p.) pretreatment with WAY-100635 inhibited ACTH and PRL responses to 8-OH-DPAT, whereas LY-206130 only inhibited the PRL response and NAN-190 had no effect. Injected i.p., the antagonists had no effect on 5-HT-induced hormone secretion, whereas the ACTH-stimulating effect of 5-HTP + Flx was increased by WAY and NAN. A 5-min restraint stress increased ACTH and PRL secretion; the ACTH, but not the PRL response to stress was inhibited by prior administration of WAY-100635 or LY-206130 either i.c.v. or i.p. NAN-190 had no effect on any stress response tested. It is concluded that (1) the three 5-HT(1A) antagonists used in our study have differential effects on stimulated hormone responses, (2) the antagonists exert different effects when administered systemically or centrally, and (3) the 5-HT(1A) receptor is involved in restraint stress-induced ACTH, but not PRL secretion.

5-Hydroxytryptophan↗
PubMed2000

Epidural local anaesthetics versus opioid-based analgesic regimens on postoperative gastrointestinal paralysis, PONV and pain after abdominal surgery.

BACKGROUND: Gastrointestinal paralysis, nausea and vomiting, and pain, are major clinical problems following abdominal surgery. Anaesthetic and analgesic techniques that reduce pain and postoperative nausea and vomiting (PONV), and prevent or reduce postoperative ileus, may reduce postoperative morbidity, duration of hospitalisation and hospital costs. OBJECTIVES: To compare effects of postoperative epidural local anaesthetic with regimens based on systemic or epidural opioids, on postoperative gastrointestinal function, postoperative pain, PONV and surgical/anaesthetic complications. SEARCH STRATEGY: Trials were identified by computerised searches of the Cochrane Controlled Trials Register, MEDLINE, EMBASE and by checking the reference lists of trials and review articles. SELECTION CRITERIA: Randomised controlled trials comparing the effects of postoperative epidural local anaesthetic with systemic or epidural opioids. DATA COLLECTION AND ANALYSIS: Collected data included treatment in active (local anaesthetic) and control (opioid based) groups, time to first postoperative stool, time to first postoperative flatus, gastric emptying measured by the paracetamol absorption test, duration of the passage of barium sulphate, pain assessments, use of supplementary analgesics, nausea, vomiting and surgical/anaesthetic complications. MAIN RESULTS: Most studies in this review involved a small number of patients. Furthermore half of the studies indicated a poor level of methodology in particular regarding blinding and report of withdrawals. Heterogeneity of included studies was substantial. Results consistently showed reduced time to return of gastrointestinal function in the epidural local anaesthetic group compared with groups receiving systemic or epidural opioid (37 hours and 24 hours, respectively). Postoperative pain was comparable. Two studies compared the effect of epidural local anaesthetic with a combination of epidural local anaesthetic and opioid on gastrointestinal function. One study favoured epidural local anaesthetic and one study was indifferent. A meta analysis of five of eight studies comparing the effect of epidural local anaesthetic with a combination of epidural local anaesthetic and opioid on postoperative pain, yielded a reduction in VAS pain scores (0-100 mm) on the first postoperative day of 15 mm, in favour of the combination. No significant differences in PONV were observed between epidural local anaesthetic and opioid based regimens. REVIEWER'S CONCLUSIONS: Administration of epidural local anaesthetics to patients undergoing laparotomy reduce gastrointestinal paralysis compared with systemic or epidural opioids, with comparable postoperative pain relief. Addition of opioid to epidural local anaesthetic may provide superior postoperative analgesia compared with epidural local anaesthetics alone. The effect of additional epidural opioid on gastrointestinal function is so far unsettled. Randomized, controlled trials comparing the effect of combinations of epidural local anaesthetic and opioid with epidural local anaesthetic alone on postoperative gastrointestinal function and pain are warranted.

Abdomen↗